An Unusual Presentation of Medullary Thyroid Carcinoma

Das, Soumyajit; Varshney, Himanshu; Saha, Makhan; Sen, Sumit; Maity, Amit Bikram; Paul, Ranjan Rashmi

doi:10.1007/s12070-013-0624-z

Cited by 5 publications

(9 citation statements)

References 7 publications

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“…According to a previous report [18], PTH immunostaining is frequently weak or shows focal positivity, particularly in adenoma, carcinoma, and oxyphilic cells. Chromogranin A is also expressed in medullary carcinoma of the thyroid [19]. Ordóñez has reported that GATA-3 nuclear expression was revealed by immunohistochemistry in all hyperplastic parathyroid glands, as well as parathyroid adenomas and carcinomas [7].…”

Section: Discussionmentioning

confidence: 99%

Diagnostic value of GATA-3 in cytological identification of parathyroid tissues

et al. 2016

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Parathyroid and thyroid lesions appear morphologically similar in cytological smears, and their differentiation can be difficult. The purpose of this study was to determine the diagnostic value of T-cell-specific transcription factor GATA-3 as a marker of parathyroid differentiation in cytology specimens, and to examine the utility of liquid-based cytology (LBC). Cytology smears obtained from surgically removed parathyroid and thyroid specimens, including 15 normal parathyroid glands, 12 cases of parathyroid hyperplasia, 55 parathyroid adenomas, 2 follicular thyroid adenomas, and 3 papillary thyroid carcinomas, were examined by immunocytochemistry using antibodies against GATA-3, parathyroid hormone (PTH), chromogranin A, and thyroid transcription factor 1 (TTF-1). All normal and hyperplastic parathyroids and 98.2% of parathyroid adenomas were positive for GATA-3, while 33.3%, 66.7%, and 60.0% of them, respectively, were positive for PTH. The positive rates for chromogranin A among normal parathyroids (80.0%) and parathyroid adenomas (87.3%) were lower than those for GATA-3. At the same time, all thyroid-derived tumours were positive for TTF-1 and negative for GATA-3, PTH, and chromogranin A. LBC smears of 35 parathyroid lesions indicated that the positive rates for GATA-3, PTH, and chromogranin A were 97.1 %, 97.1%, and 100%, respectively, while in conventional smears, those for PTH (25.5%) and chromogranin A (78.7%) were significantly lower (p < 0.01). Our results suggest that GATA-3 is a more reliable biomarker than PTH or chromogranin A in differentiating parathyroid from thyroid lesions in cytology smears and that LBC is useful in detecting cytoplasmic antigens such as PTH and chromogranin A.

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Section: Discussionmentioning

confidence: 99%

Diagnostic value of GATA-3 in cytological identification of parathyroid tissues

et al. 2016

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“…Single soft tissue metastasis of MTC is extremely rare, although several case series show an unusual presentation of distant metastases of MTC [6–8]. We searched the PubMed database using the keywords “medullary thyroid carcinoma or MTC”, “cutaneous or subcutaneous metastasis,” and “soft tissue metastasis.” We found several cases reports of cutaneous metastasis of MTC [7, 8].…”

Section: Discussionmentioning

confidence: 99%

Initial clinical presentation of single soft tissue metastasis of medullary thyroid carcinoma without primary tumor in the thyroid gland

et al. 2017

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BackgroundSingle soft tissue metastasis of medullary thyroid carcinoma is extremely rare. In addition, several occult medullary thyroid carcinomas with distant metastasis were reported, but undetectable primary lesion at diagnosis was also extremely rare.Case presentationA 74-year-old man was admitted to our hospital because of a painful nodule in his left buttock for over 1 year. Needle biopsy was performed, and the histological findings revealed adenocarcinoma positive for thyroid transcription factor-1. No evidence of a primary tumor, including the lung and thyroid gland, could be found elsewhere despite detailed examinations, including thyroid echography, chest computed tomography, and fluorodeoxyglucose-positron emission tomography. The soft tissue tumor was resected with a wide margin. Immunohistochemical analysis showed the tumor cells to be positive for cytokeratin-AE1/3, cytokeratin 7, synaptophysin, chromogranin A, calcitonin, and carcinoembryonic antigen, but negative for cytokeratin 20, Napsin A, Pax8, and p40, resulting in a diagnosis of metastasis of medullary thyroid carcinoma.ConclusionInitial presentation with a single metastasis to soft tissue and undetectable primary tumor in the thyroid gland is an extremely rare clinical manifestation in patients with medullary thyroid carcinoma.

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“…1 If the tumor is confined to the thyroid, without nodal or distant metastasis, then it is associated with prolonged survival. 1 Treatment is primarily surgical and prognosis depends upon the stage and completeness of excision.…”

Section: On Certain Occasions It Is Difficult To Differentiate Mtc Andmentioning

confidence: 99%

“…Medullary carcinoma of thyroid (MTC) is an uncommon malignant epithelial neoplasm showing parafollicular cell (C cell) differentiation. MTC has the potential to mimic other thyroid tumors morphologically . Cytological diagnosis is often difficult .…”

Section: Introductionmentioning

confidence: 99%

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Medullary carcinoma of thyroid mimicking Hurthle cell neoplasm on cytology: a diagnostic dilemma

Agarwal

Raychaudhuri

Batra³

et al. 2019

Diagnostic Cytopathology

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Medullary carcinoma of thyroid (MCT) is a neuroendocrine neoplasm derived from the parafollicular cells or C cells. It constitutes 5% of thyroid carcinomas. We present a case of 36‐year‐old female with a left lower lobe thyroid swelling since 8 to 9 years. Swelling was smooth, nontender, and moving with deglutition. Contrast‐enhanced computed tomography (CECT) findings were suggestive of malignant thyroid nodule. Fine‐needle aspiration cytology (FNAC) smears were highly cellular comprising predominantly Hurthle cells arranged in sheets, clusters, and follicles with few singly scattered cells. Background was hemorrhagic with scant colloids. An impression of follicular neoplasm or suspicious of follicular neoplasm was given with an additional note mentioning that the possibility of Hurthle cell neoplasm could not be excluded. Left hemithyroidectomy was done and sections showed a well‐circumscribed tumor suggestive of MCT, which was confirmed based on immunohistochemistry for calcitonin and carcinoembryonic antigen. It is difficult to differentiate MCT from Hurthle cell neoplasm. There may be cellular pleomorphism within a single aspirate, but the presence of mixed cell population is a diagnostic pointer for MCT. In the presence of predominant Hurthle cell population, distinguishing these entities by cytomorphology alone is difficult. Hence, clinical findings and histopathology with immunohistochemistry are mandatory in such cases to reach to a correct diagnosis to ensure proper management.

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An Unusual Presentation of Medullary Thyroid Carcinoma

Cited by 5 publications

References 7 publications

Diagnostic value of GATA-3 in cytological identification of parathyroid tissues

Diagnostic value of GATA-3 in cytological identification of parathyroid tissues

Initial clinical presentation of single soft tissue metastasis of medullary thyroid carcinoma without primary tumor in the thyroid gland

Medullary carcinoma of thyroid mimicking Hurthle cell neoplasm on cytology: a diagnostic dilemma

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